Special Issue "Radiation and Cancers"

Guest Editor
Prof. Dr. Ritsuko U. Komaki
Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Website: http://faculty.mdanderson.org/Ritsuko_Komaki/
E-Mail: rkomaki@mdanderson.org

Dear Colleagues,

I would like to invite you a very exciting issue entitled as "Radiation and Cancer" in Cancers.

X-Rays were discovered in 1985. Since then X-rays had been used in Europe, America and rest of the world in primitive planning and deliver for the cancer till recently. Parallel to the discovery of X-rays, Becquerel and Curie discovered radioactive material in 1998. During the early 1900s, radiobiological experiments were conducted with simple biologic systems corresponding with the development of radiation therapy. However it took long time to get adequate imaging studies to demonstrate location and extent of the cancer by computerized tomography (CT), magnetic resonant imaging (MRI), positron emission tomography (PET) and other functional or metabolic imaging. These imaging studies are essential to plan and deliver radiation treatment to kill cancer cells without causing excessive normal tissue toxicities and/or secondary malignancies. Now we are able to 3 dimensional conformal radiotherapy (3DCRT), 4 D-RT accounting time, Stereotactic Radiotherapy, Intensity Modulated Radiotherapy (IMRT) and particle Radiotherapy such as Proton and Carbon Iron. Discovery of mechanism of radiation resistant cells and development of radiation sensitizers including chemotherapy and molecular targeting treatment are essential to improve therapeutic ratio.

Our main goal is here to show how we plan and deliver Radiation Therapy for different type of Cancer with or without other modalities demonstrating less normal tissue toxicities and better outcome.

Hope you can join me.

Sincerely,

Ritsuko Komaki, M.D.
Guest Editor

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed Open Access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 500 CHF (Swiss Francs). English correction and/or formatting fees of 250 CHF (Swiss Francs) will be charged in certain cases for those articles accepted for publication that require extensive additional formatting and/or English corrections.

Type of Paper: Review
Title: Recent Advancement of Planning and Delivery of Radiation Therapy for Cancer
Author: Ritsuko Komaki
Affiliation: Radiation Oncology, Gloria Lupton Tennison Distinguished Professor in the Lung Cancer Research, UT MD Anderson Cancer Center, Unit 97, 1515 Holcombe Blvd., Houston, TX 77030, USA; E-Mail: rkomaki@mdanderson.org
Abstract: X-Rays were discovered by the German Physicist Wilhelm Conrad Roentgen in 1985 demonstrating the photographic film of a hand with a ring. He became the father of diagnostic radiology and radiation physics. In 1897, Professor Freund at the Vienna Medical Society to demonstrate disappearance of a hairy mole by application of x-rays. Since then X-rays had been used in Europe, America and rest of the world in primitive planning and deliver for the cancer till recently. Parallel to the discovery of X-rays, Becquerel and Curie discovered radioactive material in 1998. During the early 1900s, radiobiological experiments were conducted with simple biologic systems corresponding with the development of radiation therapy. However it took long time to get adequate imaging studies to demonstrate location and extent of the cancer by computerized tomography (CT), magnetic resonant imaging (MRI), positron emission tomography (PET) and other functional or metabolic imaging. These imaging studies are essential to plan and deliver radiation treatment to kill cancer cells without causing excessive normal tissue toxicities and/or secondary malignancies. Now we are able to 3 dimensional conformal radiotherapy (3DCRT), 4 D-RT accounting time, Stereotactic Radiotherapy, Intensity Modulated Radiotherapy (IMRT) and particle Radiotherapy such as Proton and Carbon Iron. Discovery of mechanism of radiation resistant cells and development of radiation sensitizers including chemotherapy and molecular targeting treatment are essential to improve therapeutic ratio.

Type of Paper: Review
Title: A Systematic Review of the Role of Re-Irradiation in Recurrent High-Grade Glioma (HGG)
Author: Maurizio Amichetti
Affiliation: ATreP - Provincial Agency for Proton Therapy, via Perini 181, I-38122 Trento, Italy; E-Mail: amichett@atrep.it
Abstract: Despite the use of more effective multimodal (surgery, radiotherapy and chemotherapy) treatments in high-grade glioma (HGG), the outcome of patients affected by HGG is still dismal and recurrence is a very common event. Many therapeutic approaches alone or combined (surgery, drugs, targeted agents, immunotherapy, radiotherapy, supportive therapy) are actually available in the clinic for this occurrence. The attitude of the physicians is increasingly interventionist but recurrent HGG still remains a very difficult tumor to treat. Radiotherapy with different re-irradiation strategies is more frequently proposed as a therapeutic option with interesting results, even though the duration of response is usually quite short. Most lesions re-recur locally being inadequate identification and targeting of viable tumor the most important cause of failure. Prognosis is affected by many patient-, tumor-, and treatment-associated prognostic factors. Radiotherapy is delivered with many modalities: 3D-CRT, IMRT, stereotactic fractionated radiotherapy, radiosurgery, brachitherapy, associated or less to chemotherapy. In order to evaluate feasibility and efficacy of irradiation in this field, we reviewed the literature on this argument with the method of the systematic review searching in the Medline database for the data published in English language from 1990 to 2010. The results in term of N. of studies, N. of patients, Treatment type, and % of survival are reported with some critical evaluation and comment on future opportunities In our radiation therapy demonstrated to be an acceptable option in recurrent HGG with good chances of response and a low risk of unacceptable toxicity.

Type of Paper: Review
Title: Postoperative Radiation Therapy for Thoracic Malignancies
Author: Daniel Gomez
Affiliation: Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA;
E-Mail: DGomez@mdanderson.org
Abstract: For many thoracic malignancies, surgery, when feasible, is the preferred upfront modality for local control.  However, adjuvant radiation plays an important role in minimizing the risk of locoregional recurrence. Tumors in this category include certain subgroups of non-small cell lung cancer (NSCLC), as well as thymic malignancies.  The indications, radiation doses, and treatment fields vary amongst subtypes of thoracic tumors, as does the level of data supporting its use.  For example, in the setting of NSCLC, postoperative radiation is typically reserved for close/positive margins or N2/N3 disease, though diseases such as superior sulcus tumors present a unique case in which the role of neoadjuvant vs. adjuvant treatment is still being elucidated.  In contrast, for thymic malignancies, postoperative radiation therapy is often delivered in initially resected Masaoka stage III or higher disease, with stage II remaining controversial in this regard.  This review provides an overview of postoperative radiation therapy for thoracic tumors, with a separate focus on superior sulcus tumors and thymoma, including a discussion of acceptable radiation approaches and an assessment of the current controversies involved in its use.

Type of Paper: Article
Title: Intraoperative Radiotherapy with Image-Guided Enzyme Targeting Radiosensitization (KORTUC-IORT) for Locally Advanced Pancreatic Cancer (Stage IVa)
Authors: Akihito Nishioka and Yasuhiro Ogawa
Affiliations: Dept. of Diagnostic Radiology & Radiation Oncology, Medical School, Kochi University, 783-8505, Japan; E-Mail: ogaway@kochi-u.ac.jp (Y.O.)
Abstract: We developed a new radiosensitizer injection containing hydrogen peroxide and sodium hyaluronate just followed by intraoperative radiotherapy (IORT) for locally advanced pancreatic cancer (stage IVa), named KORTUC-IORT (Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas + IORT). The purpose of this study was to evaluate the safety and efficasy of KORTUC-IORT. Fourteen patients were treated with KORTUC-IORT, external beam radiotherapy (EBRT), and systemic chemotherapy. With KORTUC-IORT, the agent was injected into tumor tissue just prior to administration of IORT under ultrasonic guidance. After IORT, the patients were treated with EBRT and chemotherapy with gemcitabine hydrochloride. For evaluation of therapeutic and adverse effects, all patients were examined at regularly scheduled follow-up visits. Medical examinations were performed every month. Contrast-enhanced computed tomography was also performed at pre-treatment, and at one month and six months after KORTUC-IORT. All treatments including KORTUC-IORT were well tolerated, with few adverse effects. The patients did not experience any severe complications. One year survival rate is 80% and median survival period is more than 15 months. The present formulation can be delivered safely and effectively under the conditions used.

Type of Paper: Article
Title: Evaluation of Changes in Tumor Shadows and Microcalcifications on Mammography following KORTUC II, a New Radiosensitization Treatment without Any Surgical Procedure for Elderly Patients with Stage I and II Breast Cancer
Authors: Akira Tsuzuki, Yasuhiro Ogawa, et al.
Affiliation: Department of Radiology, Medical School, Kochi University, Oko-cho , Nankoku-shi, Kochi-Prefecture 783-8505, Japan;
E-Mail: ogaway@kochi-u.ac.jp (Y.O.)
Abstract: In recent years, local therapeutic procedures for breast cancer are expected to be minimally invasive on the basis that permanent curability is estimated to be comparable to that of wider resections. Therefore, we introduced non-surgical therapy with a novel enzyme-targeting radiosensitization treatment, Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, Type II (KORTUC II) into early stages breast cancer treatment. The purpose of this study was to examine changes in tumor shadows and microcalcifications on mammography (MMG) following KORTUC II for elderly patients with breast cancer. We also sought to determine whether MMG was useful in evaluating the therapeutic effect of KORTUC II. In addition to MMG, positron emission tomography-computed tomography (PET-CT) was performed to detect both metastasis and local recurrence. In all 10 patients, tumor shadows on MMG completely disappeared in several months following the KORTUC II treatment. The concomitant microcalcifications also disappeared or markedly decreased in number. Disappearance of the tumors was also confirmed by the profile curve of tumor density on MMG following KORTUC II treatment; density fell and eventually approached that of the peripheral mammary tissue. The examples of changes in size of tumor shadows and microcalcifications are shown in the Figures. These 10 patients have so far shown neither local recurrence nor distant metastasis also on PET-CT with a mean follow-up period of approximately 27 months at the end of September, 2010.We concluded that breast-conservation treatment using KORTUC II followed by aromatase inhibitor is a promising therapeutic method for elderly patients with breast cancer, in terms of avoiding any surgical procedure. Moreover, MMG is considered to be useful for evaluating the efficacy of KORTUC II.

Type of Paper: Review
Title: Radiation Therapy for Renal Cell Cancer
Author: Robert J. Amato
Affiliation: Department of Internal Medicine, Division of Oncology, The University of Texas Health Medical School, Memorial Hermann Cancer Center, 6410 Fannin Street, Suite 710, Houston, TX 77030, USA; E-Mail: robert.amato@uth.tmc.edu
Abstract: Renal Cell Cancer (RCC) is traditionally considered to be radio-resistant and the conventional dose fraction size of 1.8–2.0 Gy is thought to have little role in the management of primary RCC especially in terms of cure. In the setting of metastatic RCC, conventional radiotherapy has been an effective palliative treatment in approximately 50% of patients. More importantly, brain metastases from RCC have been successfully treated with stereotactic radiosurgery (SRS) with local control rates of more than 85%. The advances in technology and physics in radiation oncology have led to the clinical implementation of image-guided radiation therapy and body stereotaxis. Thus, it is now possible to deliver very high and biologically potent dose to the tumors extra-cranially. Therefore, primary RCC as well as RCC metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance and stereotaxis allow for the delivery of a precise high-dose radiation in a few fractions. Furthermore, combining SBRT with novel targeted therapy such as tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors to maximize both local and systemic control will be reviewed.

Type of Paper: Article
Title: Using Cyberknife Radiosurgery For Medically Unresectable Stage I Non-Small Cell Lung Cancer
Authors: Mark McLaughlin, Rodolfo Bordoni, JJ Whitaker, Jonathan Chen, Alexander Gluzman and Kenneth Haile
Affiliation: Georgia Cancer Specialists, Atlanta, Georgia, USA; E-Mail: Rodolfo.Bordoni@gacancer.com (R.B.)
Abstract: Objectives: The treatment of choice for stage I non-small cell lung cancer (NSCLC) is surgery. However, many have medical contraindications to surgery. At our institution, the role of the thoracic surgeon is critical in the management of all stage I NSCLC patients, with most patients undergoing surgery and those medically unresectable underwent CyberKnife radiosurgery. Methods: Since October 2006, 169 patients with NSCLC, stage I were treated with CyberKnife Stereotactic Radiosurgery. Treatment consisted of 60 Gy in 3 to 50 Gy in 4 fractions, depending on peripheral versus central location of the tumor. Results: Ninety-three patients all with minimum 2 year follow-up were evaluated. Local control was accessed by PET/ CT criteria. The overall local control was 86% for these patients. For tumors 1 cm or less: 93% local control; 1-2 cm: 89%; 2.1-3 cm: 85% and 3.1-4 cm 78%. The pneumonitis risk was 1.6%. Every 4-6 months pulmonary function testing was repeated. No appreciable change was demonstrated in relationship to the radiosurgery treatment. The risk of pneumonothorax was 27%; 16% required chest tube placement. Two patients required surgical intervention for pleural closure. One patient died from bleeding after fiducial placement. Conclusions: Medically unresectable patients can be successfully treated with radiosurgery. The minimum follow-up was 2 years with local control at 86%. Internationally, other studies have shown results similar to these. MD Anderson has sponsored a randomized trial randomizing medically resectable patients to surgery versus CyberKnife radiosurgery. The risk of pneumothorax is being addressed with safer ways of placing fiducuals and in some situations, the ability to treat patients without fiducial placement.